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Urology > Week 1 - lecture pt 1A, 1B > Flashcards

Week 1 - lecture pt 1A, 1B Flashcards

1
Q

daily urine volume and required water intake qh?

A

~1500-2500 mL, requires ~150-250 mL water intake qh

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2
Q

ddx of GU cause of fever?

A

acute PN
malignancy
acute prostatitis
epididymitis

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3
Q

ddx of GU complains with no fever?

A

simple cystitis, chronic PN

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4
Q

ddx of GU complaints with weight loss?

A

advanced cancer

renal insufficiency dt obstruction or infection

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5
Q

ddx of failure to thrive in children (GU causes)?

A

chronic obstruction, UTI, both, etc.

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6
Q

area/pattern of pain: localized to ipsilateral CVA

refers to umbilicus, testicle, labium

A

KD

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7
Q

pain is constant vs pain comes and goes

A

constant: KD origin, infectious

comes and goes: KD origin, obstructive

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8
Q

distention vs spasm pain?

A

distention will cause a dull ache
spasms present more as colic
both usu pain is coming from ureters

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9
Q

DDX of pain from bladder: burning pain w/voiding felt in suprapubic area? painful suprapubic area? little or no pain?

A

burning pain w/voiding in suprapubic area = acute cystitis
painful suprapubic area = acute urinary retention
little or no pain = chronic retention

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10
Q

vague discomfort, fullness in perineal, rectal or lumbrosacral area?

A

prostate (BPH)

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11
Q

pain in flaccid penis dt? pain in erect penis dt?

A

flaccid: inflammation dt STI, paraphimosis
erect: Peyronie’s dz, priapsim

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12
Q

testicular pain relieved with elevating the testicle?

A

epididymitis

torsion pain will NOT BE relieved with elevation of the testicle

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13
Q

renal pain caused by what? causes?

A

sudden distention of the renal capsule

causes: acute PN, acute ureteral obstruction

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14
Q

radicular pain caused by what?

A

poor posture, arthritic changes to local jts, impingement of subcostal nerve, intervertebral disc pressure, herpes zoster

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15
Q

ssxs of irritative micturation?

A

urgency, frequency, dysuria, nocturia

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16
Q

ssxs of obstructive micturation?

A

hesitancy, decreased force of stream, dribbling

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17
Q

20-40 M/F, pain throughout micturation, burning pain, no referral, no fever, polyuria, urethral d/c, inflamed urethra, no suprapubic pain w/palpation, (=) CVA tenderness, UA shows pyuria, bacteriuria and hematuria?

A

urethritis

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18
Q

F 15+ yrs, M: infant and elderly, pain midstream and late, burning pain, no referral pain or may cause dull abd or perineal pn, no fever, polyuria, gross hematuria, fatigue, suprapubic pn w/palpation, mildly (+) CVA, pyruia, bacteriuria, hematuria on UA

A

cystitis

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19
Q

F 15+ yrs, M: infant and elderly, variable timing of pn, mb burning pain, flank and abd pn, fever usu present and usu high, polyuria, myalgia, fatigue, weakness, N/V, painless suprapubic palpation unless concomitant dz process, CVA strongly (+), pyuria, bacteriuria, hematuria on UA

A

pyelonephritis

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20
Q

M 30+ yrs, variable timing of pn w/micturation, dull pelvic pn, pain referred to testes, general pelvic region, no fever, polyuria, altered libido, pn w/ejaculation, painless suprapubic palpation, mildly (+/=) CVA, pyuria or negative UA

A

chronic prostatitis

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21
Q

volumes related to bladder outlet obstruction?

A

20-25 ml/s in M, 25-30 mL/s in F = normal
<15 mL/s = suspect obstruction
<10 mL/s = definitive evidence of obstruction

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22
Q

if hesitancy, loss of force of stream, terminal dribbling suspect what?

A

BPH, urethral stricture

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23
Q

if urinary retention suspect what? what two forms are there?

A

acute: sudden inability to urinate, agonizing suprapubic pn w/urgency
chronic: hesitancy, reduced force, little discomfort, dribblign

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24
Q

if interruption of stream suspect what?

A

bladder stone, pain may radiate to urethra

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25
Q

if sense of residual urine could be what?

A

recurrent cystitis

26
Q

if experiencing incontinence assume what anatomical abn?

A

sphincter abn

27
Q

oliguria vs anuria?

A

oliguria <500 mL urine/d

anuria <100 mL urine/d

28
Q

definition of microscopic hematuria?

A

excretion of >3 RBC/hpf

can come from anywhere along the tract

29
Q

asx microscopic hematuria usu from where? gross hematuria usu from where?

A

asx microscopic: usu renal

gross hematuria: uroepithelial

30
Q

gross, painless hematuria often 1st manifestation of what?

A

urothelial tumor

31
Q

RFs for hematuria?

A

smoking, analgesic abuse, occupational exposures, medications, recent URI, HTN, pelvic irradiation, FHx of renal dz

32
Q

if painless hematuria what do you need to assume it is until you rule it out?

A

tumor of bladder, kidney or prostate

33
Q

if hematuria at start of urination? if end? if throughout? if cyclically with menstruation (but not vaginal source)? if blood btw voidings?

A

start: anterior urethral lesion
end: bladder trigone, prostate, bladder neck, posterior urethra
throughout: bladder, ureteral, renal pathology
cyclically: endometriosis of urinary tract
blood btw: bleeding on either end of the urethra

34
Q

causes of hematuria? (VINDIC[A]TE)

A

Vascular: hemangioma, AV malformation, renal vein thrombosis, arterial emboli to KD
Inflammatory: UTI, STI, GN, PN, radiation nephritis/cystitis, IC, TB, endocarditis
Neoplasm: prostate, urethra, bladder, ureter, KD, BPH, endometriosis
Drugs: nephrotoxins, aminoglycosides, cyclosporine
Idiopathic: oral contraceptives
Congenital: cystic dz, polycistic KD, solitary renal cyst, benign familial hematuria, Alport syndrome
Trauma: exercise-induced, abd trauma, pelvic fx, iatrogenic (catheterization), foreign body
Endocrine/metabolic: bleeding dyscrasias, hemophilia, Henoch-Scholein purpura, sickle cell animea

35
Q

DDX hematuria?

A

dyes, pseudohematuria from dehydration, foods (beets, rhubarb, berries), vaginal source, genital/perineal trauma, drugs

36
Q

workup for hematuria?

A

UA, complete microscopy, urine C and S, coag screen, renal fxn tests, PTT, CBC, PSA (when indicated), urine cytology
be sure to consider hx: if UA clear, repeat in 1 week
if hx of trauma or exercise induced then repeat in 24-48 hrs
consider if it actually was a CCMS
complete UA should be done in all high risk groups for CA, previous hx of stones or renal dz

37
Q

what to do if cause is unclear?

A

refer to urologist/nephrologist

38
Q

when palpating the KDs, if tender what can this indicate? if mass? if pitting edema in the area? if abd stystolic bruits hear? is visible mass in child?

A

tender: infxn
mass: hydronephrosis, tumor or infxn
pitting: perinephritic infxn
systolic bruits: stenosis or aneurysm of renal artery
visible mass in child: Wilm’s tumor

39
Q

when is it C/I to do DRE?

A

acute urethral d/c
acute prostatitis
acute prostocystitis
CaP

40
Q

4 clues to renal abn on general PE?

A
  1. gross deformity of external ear in child & ipsilateral maldevelopment of facial bones may have congenital abn of ipsilateral KD
  2. lateral displacement of the nipples can be assoc. w/BL renal hypoplasia
  3. renal abn seen w/congenital scoliosis and kyphosis
  4. general appearance - skin brown, pallor, uremic frost
41
Q

if urine smells like ammonia? sweet-brown or frothy? fruity-sweet? maple syrup? foul smelling?

A 
ammonia= bacterial
sweet-brown or frothy = bile
fruity-sweet = ketones
maple syrup = MSUD, fenugreek
foul = fecal contamination
42
Q

random SG >1.020 is a good indication of what?

A

intrinsic KD dz

43
Q

optimal pH on UA? protein should be? glucose (+) when blood glucose above what? blood? nitrite? leukocyte esterase? ketones? urobilinogen? bilirubin?

A

pH ~6.5 optimally - acidic in lung dz, DM, diarrhea, dehydration; alkaline in renal failure, proteus infxn, hyperventilation
protein should be (=), dip picks up albumin not globulin! if >3.5 g/d on 24 hr collection then nephrotic syndrome!
glucose should be (=), spills into urine when >170
blood should be (=), dilute urine SG <1.008 will lyse RBCs
nitrites should be (=), can indicate coagulase-splitting bac (E. Coli, enterobacter, pseudomonas)
leukocyte esterase should be (=)
ketones should be (=), could indicate DM, anorexia, dehydration, N/V, fasting, wt loss, EtOH intoxication
urobilinogen should be (=), often first sign of viral hepatitis!!
bilirubin should be (=)

44
Q

if elevated bilirubin and urobilinogen suspect what?

A

liver dysfxn

45
Q

if high bilirubin but neg uro suspect what?

A

biliary stasis

46
Q

if high urobilinogen but neg bili suspect what?

A

hemolytic cause

47
Q

when do you see RBC casts?

A

acute GN or vasculitis

48
Q

when do you see broad, waxy casts?

A

nephrotic syndrome - renal failure casts

49
Q

what crystals do you seen in acidic urine? alkaline urine?

A

acidic: uric acid and calcium oxalate
alkaline: triple phosphate

50
Q

SG value showed diminished renal fxn?

A

as approaching 1.010

51
Q

urine osmolality measures what?

A

measure of urine concentration

52
Q

BUN rises when?

A

first with decreased GFR

influenced by dehydration, dietary protein, GI bleeds, drugs

53
Q

urine creatinine vs serum creatinine?

A

urine is stable #

serum can raise w/muscle metabolism, affected by diet, MS mass

54
Q

BUN:Cr ratio > 20:1 indicates what?
BUN:Cr ratio <10:1 indicates what?

A

> 20:1 indicates prerenal ARF

<10:1 indicates renal damage leading to decreased reabsorption of BUN and increase in serum Cr = intrinsic ARF

55
Q

> 3.5 g/d protein collection on 24 hr urine collection?

A

nephrotic syndrome = GBM damage

56
Q

cystatin C use?

A

serum levels will increase as GFR decrease - more sensitive than Cr, less dependent on age, gender, race, ms mass

57
Q

gold standard for measuring GFR?

A

inulin infusion

58
Q

fractional excretion of sodium used to measure what?

A

predictive of incipient ARF
<1% suggests prerenal ARF
>1% suggests intrarenal ARF

59
Q

type of anemia seen in CRF?

A

normochromic normocytic anemia

60
Q

PSA level that correlates with CaP?

A

> 4.0

61
Q

indications for renal bx?

A

persistent hematuria
nephrotic syndrome to guide tx
rapidly progressing GN
unexplained RF

62
Q

uroflowmetry measures what? cystometry measures what? pressure flow study measures what? electromyography used to assess what?

A

uroflowmetry: measures vol voided, time, flow rate, max flow rate
cystometry: measures volume, storage capacity, P in bladder
pressure flow study: measures both urine flow and bladder P
electromyography: can assess pelvic floor or periurethral ms activity for abn contraction/relaxation

Urology (9 decks)

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